Bloomfield Joy, Pénager Cécile, Mandelbrot Laurent
Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris, Paris, France; FHU PREMA, Paris and Colombes, France.
Assistance Publique-Hôpitaux de Paris, Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, Colombes, France; Université de Paris, Paris, France; FHU PREMA, Paris and Colombes, France; Inserm UMR1137 IAME, Paris, France.
J Gynecol Obstet Hum Reprod. 2021 Nov;50(9):102152. doi: 10.1016/j.jogoh.2021.102152. Epub 2021 Apr 19.
Cervical insufficiency is thought to be responsible for 10% of preterm deliveries. Shirodkar cerclage is among the available techniques ranging from McDonald's to definitive procedures, however the indications for the prevention of preterm births and mid-trimester miscarriages are still poorly delineated.
To describe the characteristics, obstetrical and neonatal outcomes of pregnancies with Shirodkar cerclage procedures.
We performed a descriptive retrospective single-center study, including all patients who had a Shirodkar cerclage between January 1, 2008 and December 31, 2020. The main outcomes measured were delivery at or beyond 24 and 32 weeks of gestations (WG).
55 Shirodkar cerclages were performed over the period studied. 7.3% of patients had a uterine malformation, 9% had a history of cervical conization. 74.5% had history of one or more mid-trimester miscarriages. 63.6% had a history of a failed emergency or prophylactic cerclage. The median gestational age (GA) at cerclage placement was 14 WG. There were 4 deliveries before 24 WG, 8 before 32 WG and 16 before 37 WG. Overall neonatal survival was 48/53 (90.6%). The median GA at delivery was 38 weeks (IQR 35-39), with 70.3% of vaginal deliveries.
Shirodkar cerclage was successful in more than 90% of patients, despite their obstetric history. Shirodkar cerclage may be indicated in the event of prior cerclage failure using the McDonald technique or in order to allow for correct stitch placement in very short cervixes. Its advantage over definitive cerclage is to allow for vaginal delivery.
宫颈机能不全被认为是10%早产的原因。从麦克唐纳手术到确定性手术，希罗德卡尔环扎术是现有的技术之一，然而，预防早产和孕中期流产的指征仍不明确。
描述接受希罗德卡尔环扎术的妊娠的特征、产科和新生儿结局。
我们进行了一项描述性回顾性单中心研究，纳入了2008年1月1日至2020年12月31日期间接受希罗德卡尔环扎术的所有患者。主要测量的结局是妊娠24周及以后和32周及以后的分娩情况。
在研究期间共进行了55例希罗德卡尔环扎术。7.3%的患者有子宫畸形，9%有宫颈锥切史。74.5%的患者有一次或多次孕中期流产史。63.6%的患者有紧急或预防性环扎失败史。环扎时的中位孕周为14周。有4例在妊娠24周前分娩，8例在32周前分娩，16例在37周前分娩。总体新生儿存活率为48/53（90.6%）。分娩时的中位孕周为38周（四分位间距35 - 39周），70.3%为阴道分娩。
尽管患者有产科病史，但希罗德卡尔环扎术在90%以上的患者中取得了成功。在使用麦克唐纳技术先前环扎失败的情况下，或为了在非常短的宫颈中正确放置缝线时，可能需要进行希罗德卡尔环扎术。它相对于确定性环扎术的优势在于可以进行阴道分娩。
